Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #0586
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
3339 W 80TH ST, HIALEAH, FL 33018-5065
(305) 396-2856
(305) 396-2856
Mailing address
PO BOX 639680, CINCINNATI, OH 45263-9680
(863) 688-1188
(863) 616-5846
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26905
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009200400
—
FL
05
—
009200401
—
FL
01
—
2139931
PK
—
Enumeration date
04/12/2013
Last updated
12/03/2019
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